October 30, 2011
Marla is a 42-year-old Hispanic female who comes to the mental health clinic complaining of having trouble sleeping, feeling “jumpy all of the time,” and experiencing an inability to concentrate. These symptoms cause problems for her at work, where she is an accountant. As a psychiatrist I would need to diagnose Marla with the proper disorder, explain information about the diagnosis, and discuss possible treatments with her. It would be near impossible to make an accurate diagnosis without more information. First, I will clinically assess Marla by asking her a few questions without her realizing right away that I am trying to diagnose her from the second she enters my office. I will ease into the conversation to gain more insight before she notices what I am doing. I would like to provide a brief interview of how I would expect it to go, given the disorder that I have diagnosed.
Hello, Marla. I am Joy Wardrip. It’s a pleasure to meet you. Will you tell me a little bit about yourself?
Marla would likely introduce herself, tell me that she is an accountant. She would go on to tell me how she has been feeling anxious for a bit and how it really distracts her from her work. She would tell me how she has trouble concentrating and that too is affecting her work. She would likely be a bit emotional, perhaps teary-eyed as she expresses her frustration with the occurrence of these recent symptoms and how she would like to symptoms to be explained and to go away. She may even express how she wants to feel “normal” again.
I understand your frustration and it is ok to feel frustrated. How long ago did you notice a change in your behavior?
Marla would let me know that she had been feeling this way for the past six to eight months. She would also tell me that she can’t remember anything that has happened in her life to explain the anxieties that she was feeling. She would tell me how she would like for things to go back to the way that they used to be.
How is your relationship with your parents?
Marla would describe a great upbringing. She would explain how she is very close to both of her parents. She would go on to describe her childhood, which was abuse and torment free. She would speak of many good memories with her parents and how she is an only child. She would go on to tell me that she was quite spoiled and had no bad memories of being a young girl.
Is there any mental illness that runs in your family? Also, have you ever been diagnosed with any disorders or are you on any type of medication?
Marla would tell me that no psychological disorders were apparent in her family and that she is not currently taking any medication. She would tell me that she had only just recently went to her family doctor to discuss her symptoms and that the doctor recommended that she speak with someone to find the root of her troubles and to explore the possibility of her having a disorder. She would tell me that is why she came to see me.
What was life like before you felt the symptoms that you have described to me?
Marla would respond with how she was always very happy, always smiling. She would tell me how she lived a worry-free life and was very social. She would discuss how she had many friends and how she enjoyed her work. She would describe herself prior to the symptoms as someone who was very optimistic and upbeat. She would then go on to say that she only just realized that it had been quite a while since she had gone out and dined with any of her friends.
Have you suffered any type of trauma? This can include anything from your past that caused you great pain or suffering mentally or physically. This could be an accident, death of someone close to you or abuse.
Marla would bring up her childhood again and remind me that it was abuse free. She would also let me know that she had never been in a car accident, aside from a fender bender which really caused no damage to herself or her vehicle for that matter. She would tell me that she had been a victim of an earthquake years ago but that it didn’t seem to affect her anymore. She said that she was a bit shaken after the earthquake but that she had moved passed it almost effortlessly and that she hadn’t even really thought about the incident in some time. I would like to go back to something that you mentioned earlier. You said that you hadn’t gone out in a while, are their certain situations that you try and avoid because of your anxiety?
Marla would explain that she didn’t like going to work. That she was missing several days because she felt uncomfortable in her office. She would explain that the more that she called in the less motivated she got to go and that it was really causing a problem for her at the workplace. She would tell me that she was afraid if something didn’t give, she would be fired. She would tell me how she wanted to leave while working because she felt claustrophobic, as though she needed to get some air or go clear her head. You mentioned that you have been having trouble sleeping here lately. Can you tell me a little more about that? Do you know of anything that may have lead to the trouble sleeping? Marla would tell me that she had been having trouble sleeping throughout the night. She would let me know that she didn’t struggle to get to sleep; she just had trouble staying asleep. She would let me know that it was really irritating her and that it was affecting her at work. She would tell me that she wasn’t arriving late to work but that she didn’t feel that she had gotten enough rest when she got to work and that she felt very tired during the work day. Do you often have dreams that recur often or do you have nightmares often? Also, how often do you wake and remember your dreams and what do you remember about them? Marla would likely tell me that she didn’t dream often, nor did she have nightmares. She might say that perhaps she doesn’t remember the dreams once she has awakened. However, Marla would share with me that she often felt very shaken and jumpy after having waken up. Had this taken place, I may suggest that she keep a journal by her bed so that she can record anything that she remembers about her dreams and how she is feeling upon waking up. Have you ever experienced flashbacks? This is when something seems very real and the images are very clear. Perhaps you have experienced feelings similar to the feeling that you felt during the earthquake that we discussed earlier? Marla would tell me that she really struggled with flashbacks following the earthquake, but that she hadn’t had any experiences with them from some time. She would tell me that it had been a few years since she had experienced them. Following the interview, I would likely diagnose Marla with Post Traumatic Stress Disorder (PTSD). I would explain to her that it is a incapacitating anxiety disorder that is experienced by people who suffer traumatic events. I will explain that these events can be related to warfare, rape, abuse, car accidents, or in her case, an earthquake. I would explain that the traumatic event can produce many characteristic symptoms which she has described to me, such as flashbacks, inability to concentrate, insomnia, and changes in emotions. Finally, I would explain the origin of the disorder by using the cognitive model of psychology. According to this model, one must understand human thought to understand its behavior. When people show abnormal behaviors many theorists look at cognitive problems. These problems can include illogical thinking processes and maladaptive assumptions. I would then try and help her to realize what she is doing and how she is responding to the trauma of the earthquake so that she can later focus on changing her faulty ideas and thinking processes for a form of treatment. This treatment would be achieved through a series of therapies in which I teach her to calm herself and control her emotions and behaviors (Comer, 2005).
Comer, R.J. (2005). Fundamentals of abnormal psychology (4th ed.). New York, NY: Worth. Faces of Abnormal Psychology, 2007. Posttraumatic Stress Disorder: Treatment Strategy. Retrieved July 4, 2009, from http://www.mhhe.com/socscience/psychology/faces